January 2, 2013

Study Looks At Use Of Antidepressants During Pregnancy

A new study recently found that the use of antidepressants during pregnancy is not related to higher risk of infant death or stillbirth.

The researchers looked at almost 30,000 females from Nordic countries that had used a selective serotonin reuptake inhibitor (SSRI) prescription during their pregnancy; the participants were from all the Nordic Countries, including Denmark, Finland, Iceland, Norway, and Sweden.

According to the Mayo Clinic, SSRI is a commonly prescribed antidepressant that is thought to lighten the symptoms of moderate to severe depression by impacting neurotransmitters, otherwise known as chemical messengers, that impact communication among brain cells. By affecting the balance of neurotransmitter serotonin in the brain, the SSRIs can help improve an individual´s mood. SSRIs have been approved by the U.S. Food and Drug Administration (FDA) in treating depression.

"Depression during pregnancy is common with prevalences ranging between 7 percent and 19 percent in economically developed countries. Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn may cause neonatal morbidity and mortality," wrote the researchers in the background section of the paper. "Use of selective serotonin reuptake inhibitors during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown."

The team of investigators from the Karolinska Institutet, based in Stockholm, Sweden completed the study to better understand if SSRI exposure during pregnancy was related to a rise in risk of stillbirth (fetus death in the uterus), neonatal death (death within the first 28 days), or post neonatal death (death occurring from 28 days to 11 months after birth). The researchers took information on maternal use of SSRIs from prescription registration and also took data on maternal characteristics, pregnancy, and neonatal results from patient and medical birth registries.

From 1,633,877 singleton births, the scientists found 6,054 stillbirths; 3,609 neonatal deaths; along with 1,578 post neonatal deaths. 29,228 women (1.79 percent) had a prescription for an SSRI during pregnancy. The researchers discovered that women who had exposure to an SSRI during pregnancy had higher rates of still births and post neonatal deaths, than those who did not. However, the rate of neonatal death was similar among the women who had been exposed to an SSRI during pregnancy and those who were not.

"Yet in multivariate models, SSRI use was not associated with stillbirth, neonatal death, or post neonatal death. Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease," explained the authors in the article. "The present study of more than 1.6 million births suggests that SSRI use during pregnancy was not associated with increased risks of stillbirth, neonatal death, or post neonatal death. The increased rates of stillbirth and post neonatal mortality among infants exposed to an SSRI during pregnancy were explained by the severity of the underlying maternal psychiatric disease and unfavorable distribution of maternal characteristics such as cigarette smoking and advanced maternal age."

With these findings, the team of investigators believes that a comprehensive decision-making process should take place before expectant mothers fill an SSRI prescription.

"However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness," concluded the authors in a prepared statement.

The findings of the study were recently featured in the Journal of the American Medical Association (JAMA).